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Aeroallergens, allergic rhinitis, and sedating antihistamines: risk factors for traumatic occupational injury and economic impact.

BACKGROUND: The U.S. workplace injury burden is significant. Our objective was to assess the particular impact of aeroallergen, allergic rhinitis, and antihistamine exposures and side effects on the risk of traumatic work-related injuries, and the associated economic impact. METHODS: This is an observational case-control study with 1,223 acute traumatic injury cases that are compared to 1,202 chronic back injury controls. Structured telephone interviews were conducted in 1998 and 1999 on Workers' Compensation applicants injured in 1997. Antihistamine use and pollen levels were measured 2 weeks prior to the injury date. RESULTS: Sedating antihistamine exposures elevated acute injury risk (main effect OR: 2.93). A significant increase in traumatic injury risk was observed for combined sedating antihistamine and high pollen exposures among subjects with physician and self-diagnosed allergic rhinitis (OR: 2.41). Direct medical costs associated with this increased risk were estimated at $143 million in 2001. CONCLUSIONS: Workers with physician-diagnosed allergic rhinitis have as high a reliance on sedating antihistamines as do self-diagnosed and self-medicating nasal allergy sufferers. High pollen exposures along with sedating antihistamine use may confer significant additional injury risks among allergic rhinitis sufferers. Medical management "best practices" of diagnosed allergic rhinitis should include avoidance of sedating antihistamines to minimize acute, traumatic injury risks.

Adult↗

Cognitive effects of chronic exposure to lead and solvents.

BACKGROUND: Occupational exposure to lead and solvents has declined steadily over the past 20 years, however, construction workers continue to be exposed to these neurotoxicants. The purpose of this study was to investigate the cognitive effects of chronic occupational exposure to lead and solvents. METHOD: Based on K-XRF of tibial bone lead and occupational history of solvent exposure, subjects were classified into four exposure groups: lead (N = 40), solvent (N = 39), lead/solvent (N = 45), and control (N = 33). All subjects completed tests to assess concentration, motor skills, memory, and mood. RESULTS: Relative to controls, the lead, solvent, and lead/solvent groups performed significantly more poorly on a test of verbal memory, while the lead and lead/solvent groups were slower than the solvent and control groups on a task of processing speed. Bone lead was a significant predictor of information processing speed and latency of response while solvent exposure was a significant predictor of verbal learning and memory. CONCLUSIONS: Bone lead was associated with slower speed of processing while exposure to lead and/or solvents reduced efficiency of verbal learning.

Affect↗

Nested case-control study of external ionizing radiation dose and mortality from dementia within a pooled cohort of female nuclear weapons workers.

BACKGROUND: A prior investigation of this cohort of female nuclear workers found increased deaths from mental disorders, including dementia. The present study estimates the effect of workplace exposures to ionizing radiations and other hazards on mortality from dementia. METHODS: A nested case-control study within a pooled cohort of 67,976 female nuclear workers compared 91 cases of death from dementia with 910 controls. Adjusted odds ratios (ORs) were employed to estimate the effects of maximum annual and total lifetime radiation doses on the occurrence of dementia in 168 monitored workers. RESULTS: Both maximum annual (OR = 2.11, 95% confidence interval (CI) = 0.98, 4.40) and total lifetime radiation doses (OR = 2.09, 95% CI = 1.02, 4.29) were associated with death from dementia. Significant dose-response trends were present for both exposures. CONCLUSIONS: Occupational exposure to ionizing radiation (IR) may be associated with increased risk of death from dementia in female workers. Since these findings are based on a small number of cases, replication with a larger case sample should be pursued.

Adolescent↗

A survey on exposure level, health status, and biomarkers in workers exposed to 1-bromopropane.

BACKGROUND: The aim of this study was to evaluate the health effects of exposure mainly to 1-bromopropane, which is an alternative to ozone-depleting solvents, and to establish biomarkers for assessing 1-bromopropane exposure. METHODS: Twenty-four female and 13 male workers of a 1-bromopropane-factory were interviewed, and their urine and blood samples were collected. Measured parameters included 1-bromopropane levels in the factory, as well as individual exposure levels, urinary 1-bromopropane levels, enzymatic activity and M subunit's concentration of serum creatine kinase (CK). RESULTS: Frequent symptoms reported by workers exposed to 1-bromopropane were nose, throat, and eyes irritation or malaise and/or headache. Urinary 1-bromopropane levels correlated significantly with individual exposure levels, but enzymatic activity or CK-M subunit did not. CONCLUSIONS: The symptoms suggested irritation of the mucous membrane and possible adverse effects on the central nervous system. There were no severe chronic symptoms suggestive of neurological damage in workers exposed to less than 170 ppm. Urinary 1-bromopropane level may be a good indicator of exposure. Am. J. Ind. Med. 45:63-75, 2004.

Adult↗

Modeling of methyl isothiocyanate air concentrations associated with community illnesses following a metam-sodium sprinkler application.

BACKGROUND: A series of illnesses occurred in Earlimart, CA on November 13, 1999 following a metam-sodium sprinkler application to a potato field on the southern edge of the town. METHODS: Case information was obtained from direct interviews, from illness complaints filed with state or county agencies, or from illness reports filed by community physicians for 173 subjects. Air concentrations of the by-product methyl isothiocyanate (MITC) during the episode were estimated based upon the Industrial Source Complex Short-Term (ISC3) air dispersion model, estimates from prior metam-sodium monitoring studies, and data from weather stations in two adjoining communities. RESULTS: Weather station data indicated that the November 13th incident corresponded with a temperature inversion at approximately 5:00 p.m. and a shift in the direction of prevailing wind from northwest to southeast. On the edge of Earlimart, 1-hr time weighted average (TWA) MITC concentration estimates ranged from 0.5 to 1 ppm. Of the 173 subjects, 170 had MITC-compatible symptoms, including eye or upper respiratory irritation (77.6%), non-specific systemic symptoms (64.7%), and lower respiratory symptoms (20.0%). 78.2% were exposed within 0.5 miles of the northern edge of the treated field where average 1 hr MITC concentrations exceeded the 800 ppb ocular irritation threshold. CONCLUSIONS: ISC3 modeling is a useful means of evaluating MITC concentrations for illness episodes when industrial hygiene assessment is not possible.

Adolescent↗

Health symptoms and exposure to organophosphate pesticides in farmworkers.

BACKGROUND: Few studies have examined the relationship between reported health symptoms and exposure to organophosphate (OP) pesticides. METHODS: Fisher's exact test was used to assess the relationship between self-reported health symptoms and indicators of exposure to OP pesticides in 211 farmworkers in Eastern Washington. RESULTS: The health symptoms most commonly reported included headaches (50%), burning eyes (39%), pain in muscles, joints, or bones (35%), a rash or itchy skin (25%), and blurred vision (23%). Exposure to pesticides was prevalent. The proportion of detectable samples of various pesticide residues in house and vehicle dust was weakly associated with reporting certain health symptoms, particularly burning eyes and shortness of breath. No significant associations were found between reporting health symptoms and the proportion of detectable urinary pesticide metabolites. CONCLUSIONS: Certain self-reported health symptoms in farmworkers may be associated with indicators of exposure to pesticides. Longitudinal studies with more precise health symptom data are needed to explore this relationship further.

Adolescent↗

Reducing attenuation in exposure-response relationships by exposure modeling and grouping: the relationship between wood dust exposure and lung function.

BACKGROUND: In a study of wood dust exposure and lung function, we tested the effect on the exposure-response relationship of six different exposure metrics using the mean measured exposure of each subject versus the mean exposure based on various methods of grouping subjects, including job-based groups and groups based on an empirical model of the determinants of exposure. METHODS: Multiple linear regression was used to examine the association between wood dust concentration and forced expiratory volume in 1s (FEV(1)), adjusting for age, sex, height, race, pediatric asthma, and smoking. RESULTS: Stronger point estimates of the exposure-response relationships were observed when exposures were based on increasing levels of aggregation, allowing the relationships to be found statistically significant in four of the six metrics. The strongest point estimates were found when exposures were based on the determinants of exposure model. CONCLUSIONS: Determinants of exposure modeling offers the potential for improvement in risk estimation equivalent to or beyond that from job-based exposure grouping.

Adolescent↗

Solvent-related health effects among construction painters with decreasing exposure.

BACKGROUND: The prevalence of solvent-related symptoms among construction painters is unclear due to their declining exposure. METHODS: A questionnaire study was conducted on 1000 male Finnish construction painters and 1000 carpenters. Symptom questions were combined with exposure parameters, medical history, and health behavior. RESULTS: Highly significant associations were found between cumulative intensity of long-term solvent exposure (CE-LT) and symptoms of memory and concentration, and mood. CE-LT was a better measure of solvent exposure than the number of years as a painter. Exposure was also associated with diagnosed psychiatric disorders, hypertension and arrhythmia. Recent exposure in the 1990s had no major effect on symptoms. CONCLUSIONS: The results strengthen the dose-response relationship of exposure and long-term neurotoxic effects. No clear association was found between recent exposure and symptoms. Cardiovascular effects in solvent-exposed construction painters is further suggested.

Adult↗

Acute symptoms associated with asphalt fume exposure among road pavers.

BACKGROUND: Although asphalt fume is a recognized irritant, previous studies of acute symptoms during asphalt paving have produced inconsistent results. Between 1994 and 1997, the National Institute for Occupational Safety and Health (NIOSH) evaluated workers at seven sites in six states. METHODS: NIOSH (a) measured exposures of asphalt paving workers to total (TP) and benzene-soluble particulate (BSP), polycyclic aromatic compounds, and other substances; (b) administered symptom questionnaires pre-shift, every 2 hr during the shift, and post-shift to asphalt exposed and nonexposed workers; and (c) measured peak expiratory flow rate (PEFR) of asphalt paving workers when they completed a symptom questionnaire. RESULTS: Full-shift time-weighted average exposures to TP and BSP ranged from 0.01 to 1.30 mg/m(3) and 0.01 to 0.82 mg/m(3), respectively. Most BSP concentrations were <0.50 mg/m(3). Asphalt workers had a higher occurrence rate of throat irritation than nonexposed workers [13% vs. 4%, odds ratio (OR) = 4.0, 95% confidence interval (CI): 1.2-13]. TP, as a continuous variable, was associated with eye (OR = 1.34, 95% CI: 1.12-1.60) and throat (OR = 1.40, 95% CI: 1.06-1.85) symptoms. With TP dichotomous at 0.5 mg/m(3), the ORs and 95% CIs for eye and throat symptoms were 7.5 (1.1-50) and 15 (2.3-103), respectively. BSP, dichotomous at 0.3 mg/m(3), was associated with irritant (eye, nose, or throat) symptoms (OR = 11, 95% CI: 1.5-84). One worker, a smoker, had PEFR-defined bronchial lability, which did not coincide with respiratory symptoms. CONCLUSIONS: Irritant symptoms were associated with TP and BSP concentrations at or below 0.5 mg/m(3).

Acute Disease↗

Surveillance of occupational skin diseases: a method utilizing workers' compensation claims.

In order to determine the feasibility of using workers' compensation claims (WCC) for surveillance of occupational skin diseases, we reviewed all WCC received in the state of Ohio from 1980 through 1984. A total of 4,214 WCC for occupational skin diseases were filed by 2,610 Ohio companies, of which 1,656 (63%) companies were classified in Standard Industrial Classification (SIC) categories with average annual WCC rates above the overall state average for skin diseases. During the five year study period, 102 companies filed six or more WCC, of which 85 (83.3%) companies were classified in SICs with above-average WCC rates. WCC from 65 (63.7%) of these 102 companies implicated either the same occupation or causal agent in 50% or more of WCC received from each respective company. Using SIC classifications with WCC rates above the state average and six or more filed WCC as measures of risk, there was good correlation between company risk ranking by SIC categorization and number of WCC filed. This study suggests that active intervention strategies to prevent occupational skin diseases can be based on primary identification of companies filing WCC, followed by secondary identification of high-risk occupations or causal agent exposures within these companies.

Environmental Monitoring↗

Spontaneous abortions among women exposed to organic solvents.

We investigated the association between medically diagnosed spontaneous abortions and occupational exposure to organic solvents. The study population was composed of women biologically monitored for solvents. The workers were classified into exposure categories on the basis of work description and the use of solvents as reported in the questionnaires, and on biological exposure measurements. The odds ratio of spontaneous abortion for solvent exposure, adjusted for potentially confounding factors, was significantly increased (2.2, 95% confidence interval [CI] = 1.2-4.1). The increase was most consistent among workers exposed to aliphatic hydrocarbons: the odds ratio for high exposure was 3.9 (95% CI = 1.1-14.2) and for exposed graphics workers 5.2 (95% CI = 1.3-20.8). The odds ratio was increased also among toluene-exposed shoe workers (9.3, 95% CI = 1.0-84.7). The results of the study support the hypothesis of a positive association between spontaneous abortion and exposure to organic solvents during pregnancy and suggest that exposure, especially to aliphatic hydrocarbons, increases the risk of abortion.

Abortion, Spontaneous↗

Cross-shift and chronic effects of stainless-steel welding related to internal dosimetry of chromium and nickel.

Ninety welders from a stainless-steel fabricating plant were studied by pulmonary function tests and serum and urine chromium and nickel levels, cross-sectionally, and 31 were compared across a Monday shift. They had welded for a mean of 11 years, mean age was 44 years, and mean smoking duration was 20 years in 62 current smokers. Baseline spirometric tests were significantly reduced: FVC to 95.4 mean percentage of predicted (pop), FEV1 to 94.5 pop, FEF25-75 to 85.9 pop, and FEFR75-85 to 74.8 pop. Current smokers had greater reductions in flow rates and FVC than nonsmokers even after adjustment of their predicted values for the effects of duration of smoking. Neither alveolar volume at 104.3 pop nor diffusing capacity for carbon monoxide (single breath) at 98.5 pop was reduced. There were no significant changes in pulmonary function measurements across a Monday workshift in 31 welders, but in seven men who welded stainless steel, levels of serum chromium (Cr) rose 66% from 1.9 +/- 2.1 micrograms/liter and urinary Cr increased 22%. Serum nickel levels rose only 7%, although they were elevated before shift, 1.1 +/- 0.4 micrograms/liter (compared with 0.21 +/- 0.20 micrograms/liter in controls), and urinary nickel levels did not increase. Eleven years of welding had reduced vital capacities and expiratory flows. Monday stainless-steel welding raised the serum and urine chromium levels (measures of internal dosimetry for exposure) but did not decrease pulmonary function values.

Adult↗

Congenital malformations and death among the offspring of Danish pharmacy assistants.

Congenital malformations, stillbirth, and infant mortality were studied in a cohort of all female pharmacy assistants in Denmark under the age of 40 years who were members of the national union in 1979 to 1984 (4,939). Data on all births and deaths during first year of life during the study period were identified through the national birth register. Information on type of work, exposures, and life-style variables were obtained by postal questionnaires, to which 93% responded. In general, pharmacy assistants had a low frequency of congenital malformation and death among their offspring. Compared with an internal reference group, pharmacy assistants engaged in production or packing of pharmaceutical products experienced an increased prevalence of congenital malformations among their offspring. Working with identification and controls showed a slightly increased risk of death during the first year of life of the children. This could indicate occupational risks, but other explanations cannot be excluded.

Adult↗

Cross-sectional study of platinum salts sensitization among precious metals refinery workers.

A cross-sectional medical evaluation was conducted to determine respiratory and dermatological effects of platinum salts sensitization among workers in a secondary refinery of precious metals. Fifteen of 107 current employees and eight (28%) of 29 former employees, who had been terminated from employment on average for 5 years because of respiratory symptoms, had positive skin reactivity to platinum salts. Platinum salts skin reactivity was significantly associated with average air concentrations of platinum salts in employees' present work area. Workers with positive platinum salts skin tests had significantly higher prevalences of reported rhinitis, asthma, and dermatitis than negative skin test workers. They also had increased bronchial response to cold air challenge and elevated levels of total serum IgE. Platinum salts sensitization was not associated with atopic tendency as measured by sensitivity to common aeroallergens, but was strongly associated with cigarette smoking status. The findings indicate that cigarette smoking may be a risk factor for the development of platinum salts allergy. The persistence of platinum salts sensitization and high prevalence of adverse health outcomes among former workers demonstrate the importance of regular medical monitoring so that sensitized workers can be removed from exposure before they develop long-term health problems.

Animals↗

Effects of elemental mercury exposure at a thermometer plant.

This study compares 84 mercury-exposed workers at a thermometer manufacturing facility with 79 unexposed workers for evidence of chronic mercury toxicity. Personal breathing-zone air concentrations of mercury ranged from 25.6 to 270.6 micrograms/m3 for thermometer workers. Urinary mercury levels in the study population ranged from 1.3 to 344.5 micrograms/g creatinine, with eight (10%) participants exceeding 150 micrograms/g creatinine and three workers exceeding 300 micrograms/g creatinine, which indicates increased absorption of mercury among the thermometer workers. All urine mercury levels in the comparison group were compatible with normal background levels in unexposed adults (less than 10 micrograms/g creatinine). Thermometer plant workers reported more symptoms than did controls; in general, these differences were not statistically significant and could not be specifically associated with mercury exposure. Static tremor, abnormal Romberg test, dysdiadochokinesia, and difficulty with heel-to-toe gait were more prevalent among thermometer workers than control workers, which could not be associated with recent mercury exposure; there was some suggestion of an association with chronic exposure. There were no intergroup differences for the standard clinical tests of renal function except for a significantly higher mean specific gravity among the thermometer workers. A positive correlation was found, however, between urinary N-acetyl-b-D-glucosaminidase (NAG) and urinary mercury. There was no consistent evidence for intergroup differences in proximal renal tubule function, as measured by urinary beta 2-microglobulin (B2M) or retinol binding protein (RBP).

Adult↗

A practical approach to estimating the true effect of exposure despite imprecise exposure classification.

Accurate information on actual exposure to some possibly toxic agent usually is not available in long-term occupational studies. Any strategy for assigning exposure levels or categories necessarily results in misclassification, where some individuals classified as exposed have no real exposure and some individuals classified as not exposed have some exposure to the agent. Both misclassification errors serve to reduce the estimate of risk associated with exposure. The question arises, "How much does the true risk depart from the observed estimate given an assumed level of misclassification?" This paper quantifies the effect of such misclassification on several forms of standardized risk ratios. Our results express the true risk as a function of the apparent risk based on imprecise exposure classification and parameters representing the proportion of each of the groups that are correctly classified. In any practical situation, the apparent risk can be computed based on whatever classification scheme is being used. On the other hand, the proportions of the imprecisely classified groups actually exposed cannot. However, the investigator may have information or may make assumptions for likely ranges of values for these proportions. Given the apparent risk, estimated true risks can be calculated and plotted or represented in tabular form as a function of the proportions of actual exposure. The resulting graph or table enables the investigator to read off the range of possible true risk values based on what he is prepared to believe or what other information indicates about the range of proportions of misclassified subjects. For instance, results for a typical value of apparent risk of 1.8 show that the true risk may be twice the apparent risk with only 23% misclassification in each exposure group. The value of the true risk that would be necessary to be consistent with a given apparent risk increases rapidly as the extent of misclassification increases. We also show that, if the extent of misclassification is large, the apparent relative risk is close to 1.0 regardless of the actual value of the true risk. Therefore, a small apparent risk does not necessarily indicate that there is no occupational hazard.

Bias↗

Parental occupation and intracranial neoplasms of childhood: anecdotal evidence from a unique occupational cancer cluster.

Near the end of the data-collection phase of a case-control interview study of environmental factors and childhood brain tumors, an unusual space-time cluster was revealed. Not only had six genetically unrelated children been diagnosed with a primary intracranial tumor in a recent 2.4 year period in a rural county in Ohio, but each child had one parent employed by the same company (two mothers, four fathers). This represents an observed/expected ratio greater than 70 (p much less than 0.001). All tumors were microscopically confirmed, and all case parents worked at the facility in question for at least 1 year prior to conception, during the index pregnancy, and for at least 6 months after birth. The place of parental employment was an electronics firm (Standard Industrial Classification [SIC] group number 367, electronic components and accessories), where more than 100 chemical compounds are used by the company in a manufacturing process. Results of the cluster investigation are described, including a description of the case series. This cancer cluster is unique in that the index case series is composed of the offspring of workers, not the workers themselves.

Adolescent↗